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Having neck and shoulder pain. Chest x-ray normal. Lymph nodes felt above the collarbone. Any cure?

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I have been having neck, trapezius and shoulder pain and stiffness on the right side for over 6 months. I have had a normal chest x-ray. Normal non-contrast cervical mri and a normal neck x-ray. I am a smoker. Physical therapy did not help. Chiropractor did not help. Nothing has help. While massaging that area a couple weeks ago I felt a small pea sized nodule at base of right side of neck above collarbone. Went to my Physician. He did not seem concerned about the lymph node. Prescribed an anti-inflamatory for the pain and stiffness. I sit at a computer all day and have been in a temporary office during this time basically with a table and chair that has no raising or lowering capabilities. I have bad eyes and think this could be cause by my posture and looking up at the computer through my bi-focals during this temporary set up while remodeling our bldg. The pain gets pretty severe when stretching the neck especially in the crease where the neck meets the shoulder, but also over the shoulder, trapezius and neck. Can the muscle tension and inflamation cause the lymph node or can the lymph node cause all this pain and stiffness even though it is painless. I am confused. No blood work orderd etc. Is it normal to feel a pea sized nodule in that area? For all I know it could have been there forever. I only noticed it while massaging that area of my neck and shoulder. The nodule seems somewhat moveable and can feel squishy at times and hard at times depending on position of neck. Thank you so much for your help.
Posted Fri, 20 Jul 2012 in Bones, Muscles and Joints
Answered by Dr. Divya Kuttikrishnan 2 hours later

Thanks for writing in.

The lymph node which you felt right above the collarbone might be the right supraclavicular lymph node. It is quite unlikely for the lymph node to cause the pain and stiffness you are experiencing.

When your doctor examined this particular lymph node, did he/she make it a point to examine other nodes around the neck,axilla or groin.There are lot of associated factors which would worry us , like
1.the presence of other cervical or axillary lymph nodes(generalised lymphadenopathy).
2.the presence of unexplained weight loss , fever, fatigue, night sweats etc
so on and so forth.
3.the presence of a stony hard lymph node is more in favour of a malignancy

The right supraclavicular lymph node mainly drains the region of lungs, retroperitoneum ,oesophagus and is enlarged in cases of malignancy.
Some physicians would wait for 3-4 weeks(if there are no other worrisome factors) and observe if the lymph node resolves on its own or if there is any increase in size.

However, I would suggest you to get a second opinion from another physician to put your mind at ease and get an FNAC(fine needle aspiration cytology) or Excision biopsy of the lymph node if suggested by the doctor.

About the pain in the neck, have you tried pain relief gel ,hot fomentation and application of a soft cervical collar. Try to have an ergonomically designed workplace.

Hope I have answered your question. If you have any further questions, I will happy to answer them.

In case you have no further queries, kindly accept the answer. Any reviews are welcome.

Have a wonderful day.

Dr.Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Having neck and shoulder pain. Chest x-ray normal. Lymph nodes felt above the collarbone. Any cure? 7 hours later
I have an appointment next week with an ENT. I have been having the feeling of having to clear my throat and some slight nasal drainage. I am going to show him the lymph node and seek his opinion. Do you think this would be a sufficient second opinion? Also, what you are suspecting is that I have two unrelated problems with the coincedence that they happen to be in the same area? I did have a staff infection several months ago several inches away toward the back of the crease of my neck shoulder area which resolved about 3 months ago. I did not notice the lymph node at that time however I was not feeling and massaging that area.

Thank you so much for your help.
Answered by Dr. Divya Kuttikrishnan 3 hours later

Thanks for the reply.

Maintain the appointment with the ENT doctor.That is a good enough second opinion.Probably the supraclavicular lymph node has been there for some time, we do not know that for sure. If it was any other lymph node , that normally enlarges when you have cough or cold, it could be left alone. However, we do not want to take a chance with the supraclavicular lymph node, especially when you say at times it feels hard. It could be harmless ,maybe not. Supraclavicular lymph node is enlarged in cases of lung and gastro intestinal malignancies .Sometimes there is no cause for enlargement, it would have enlarged at some point when you had some infection and failed to regress back to its original size.

Probably your physician was not too concerned about the lymph node, Maybe because it was not an enlarged supraclavicular lymph node,probably just a node that gets enlarged when you have sore throat etc.

I presumed it is supraclavicular, since you said the lymph node was felt immediately/just above the collar bone at the base of the neck. I would advise you not to be anxious about the lymph node, but definitely do get a second opinion from your ENT doctor.

Meanwhile for the problem of clearing the throat and slight nasal drainage, I would suggest you have plenty of warm water and warm fluids to drink. Saline water gargles might help.In addition you could try doing steam inhalation 3 times a day.

Hope this helps.

Do get back to me if you have any further queries.

Have a nice day.

Dr.Divya Kuttikrishnan

Above answer was peer-reviewed by
Follow-up: Having neck and shoulder pain. Chest x-ray normal. Lymph nodes felt above the collarbone. Any cure? 3 days later
I had the appt. with the ENT this morning. He said the pea sized nodule was cause or was the brachial plexus and muscle. Something about where the Brachial Plexus connects to the muscle. He did not know what would have caused this or how long it has been there. It is not painful and he did not think it was the cause of the stiffness and tension in my neck, shoulder and back that I have been experiencing the last 6 month. My ligament or tendon. Does any of this make sense to you? Would it cause what feels like a pea sized nodule above the collarbone toware the right side of my neck. The ENT said it probably would not go away. He did feel around my neck all over to see if he felt any other abnormalities and did not find anything.

Maybe I just haven't noticed it because that is not a part of my body that I normally would feel and I only noticed it because of my neck and shoulder pain by massaging that area. I do not know.

Please advise on your opinion of both the Doctors diagnoses.

Thank you again.
Answered by Dr. Divya Kuttikrishnan 5 hours later

Thanks for updating me with the reports.

Well, it is a relief to know that there is no abnormality in the lymph nodes around the neck region.Another good sign is that there is no pain / altered sensation in the arm on palpation.Yet another positive thing is that your cervical X XXXXXXX and MRI reports have come back as normal.

Probably as you said, the pea sized nodule might have been there for a long time but it came to your notice now, because of your muscle pains and while massaging the area.

What you can do now is to be calm.Don't be anxious about this pea sized nodule. Maintain good posture and avoid over straining the neck and back muscles.

However , observe this nodule as to whether there is an increase in size over the next one or three months.If it stays the same size, don't worry about it.If it gets bigger , visit a surgeon, as a CT scan/MRI/FNAC/Biopsy might need to be done to rule out neurogenic tumors etc.

Hope I have answered your query. I will be happy to answer any further queries you might have . In case you don't have any further queries, kindly accept this answer.Any reviews are welcome.

Have a wonderful day.

Dr.Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Having neck and shoulder pain. Chest x-ray normal. Lymph nodes felt above the collarbone. Any cure? 36 minutes later
Thank you. You did answer most of my question, however I am curious as to why a brachial plexus is or why is would cause a painless pea sized nodule on the side of my neck. I am not a doctor I just unfortunately play one too often. But this is a term I have never heard. The Dr. wrote it down for me "muscle" then "brachial plexus". I do not have this type of nodule on the left side of my neck and would think it would be symetrical. I suppose I could google it, but I am sure I could lead myself into believing from one link to another that I had something even worse going on. Just very curious about the term and what would cause it to form a small sometimes hard but moveable under the fingers nodule. I don't care that it is there for cosmetic or pain reasons. Neithe apply. I am just curious as to what could have caused this and the fact that he said it would probably not go away, which is fine as well. Then my ligament. Guess they both could mean the same things in different terminology. You have been very, very helpful to me and your answers very detailed and informative. So help me out with this Brachial Plexus. Curious.
Answered by Dr. Divya Kuttikrishnan 10 hours later

I apologize for missing that part of your question earlier about muscle/brachial plexus, and I will try to make it as simple as possible for you.

Brachial plexus is a network of nerve fibres arising from near the neck and shoulder(cervical spinal cord), and these nerves control the muscles and sensations of the fingers,hands,arms and shoulders.This network is located in the supraclavicular region(above the collar bone) between the scalenus anterior and scalenus medius muscle.Brachial plexus are present on both sides right and left.

Since you use the computer a lot, it is quite possible that you unconsciously tense your upper trapezius,scalene and forearm muscles while using the keyboard.The tension in the scalenus muscle,might have caused the muscle fibers to get matted together into a nodule.And it is only on one side,maybe because of a prediliction to keep your head rested on one side of your neck, while working on the computer.This is what I am assuming both the doctors meant. If that is the case , there is nothing to worry about. However, continue to observe the growth over 1-3 months and look for any increase in size. If it stays the same without any other major symptoms,leave it alone.

As for the neck pain continue with the physical therapy and do the physiotherapy exercises he/she might have suggested. XXXXXXX up with an oocupational therapist and have an ergonomically designed workplace. I feel once your posture and workstation is good, your neck pain and shoulder pain should subside.

Hope my answers have been of some help this time around.I will be happy to answer any further queries.

Have a great day.

Dr.Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Having neck and shoulder pain. Chest x-ray normal. Lymph nodes felt above the collarbone. Any cure? 2 days later
Can you please clarify for me. I have seen my family physician, who thinks it is where the muscle connects to the ligament and said it is nothing to worry about. I have seen an ENT who without even hesitating said it was muscle/brachial plexus and I know you cannot and will not diagnose me because you cannot see or feel the nodule, but from my explaination and description of the size, feel and location think it is a lymph node. So I either have 3 different opinions or I have 3 related opinions that each are using different terminology. I am somewhat confused, which is nothing new for me anyway. It feels like it is easier to feel. Not really larger. Just kinda feels closer to the skin and I can move it around some and push it into the tissue. It does not cause pain and is not a cosmetic problem. I am the type that cannot stop checking it. I mean almost continuously. I have probably made things worse. Check it every week. Check it once a month. Are you kidding me. That is not possible unless I put some permanent cover over it and I still would check it in the shower. I know I need to just leave it alone and check it maybe once a week. Very difficult on my part. LOL. Can you please try to explain the 3 opinions and how or if they are related to each other or if they are just different opinions.

Thank you so much.

Answered by Dr. Divya Kuttikrishnan 19 hours later

1. Your family physician may be right, and yes, he is. It has got to do with the muscle and the ligament and the strain on them due to continuous use of computer.

2. Your ENT specialist is also right. He is given you the name of the diagnosis as lymph node may or may not be right. However, its presence or absence has no much of impact on your outcome.

To sum up, both your family physician and ENT specialist are pointing towards one condition and I am giving you an opinion of a lymph node enlargement which may be associated sign.

Hope this helps.

Take care and regards,
Above answer was peer-reviewed by
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